Internal angular dermoid cyst

Case contributed by Dr Mostafa Mahmoud El Feky

Presentation

Swelling since birth adjacent to the medial canthus of the left orbit with slow increase in size over the years.

Patient Data

Age: 25 years old
Gender: Male
CT

A left-sided superficially located space occupying lesion is noted involving the medial aspect of the preseptal region of the left upper eyelid extending to the region of the inner canthus. It is still separable from the region of the left lacrimal sac. It flattens against the maxillary process of the left frontal bone and the proximal aspect of the left nasal bone. No intra-orbital or intra-cranial extension could be seen. It showed non-enhancing average MDCT density of – 130 HU (fat).

Case Discussion

The above-described features are those of a left-sided fat containing lesion most consistent with internal angular dermoid cyst. Dermoid cysts represent the most common congenital lesion of the orbit. The most common location is at the frontozygomatic suture (80%) followed by the nasal aspect of upper orbit at the frontoethmoidal suture. Orbital dermoid cysts could be diagnosed if the fatty components are found within it. Some dermoid cysts appear with fluid levels at the superior component of the lesion is a transparent field of fat and the lower component is relatively dense. It is called the "fat-floating" sign.

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Case information

rID: 44587
Case created: 28th Apr 2016
Last edited: 7th Jan 2018
System: Head & Neck
Inclusion in quiz mode: Included

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